Should Very High Cost Treatments be Covered?

The age old healthcare questions still daunt us: Should the rich get better care than the less wealthy? Should end of life treatment be subject to cost/benefit analysis? These questions came back in mind when I read today’s New York Times article, “Cancer Fight Goes Nuclear, With Heavy Price Tag” .

Nuclear particle accelerators shoot protons into tumors. The machines cost over $100M and Medicare pays about $50K per patient to treat prostate cancers. This is double the cost of X-ray treatment with no solid evidence of clinical benefit. The theoretical benefit is that protons are more targeted than X-ray, with fewer side effects. This is particularly important for eye and brain cancers.

It makes no sense to say that every patient has access to every treatment regardless of cost. This would price health insurance out of reach of the majority. Insurance companies limit use by calling certain treatments experimental. A better approach would be to sell policies for high cost treatments as riders to basic policies. The government would have to determine the boundary.

The UK currently subjects high cost cancer drugs to cost benefit analysis. Image if there was a true free market for the value of a $50K drug that only extends life by a few months. How much would people be willing to spend for insurance covering an extra few months of life? To put it another way, would the price of these drugs fall if they were not covered by insurance?

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